I was wondering when immigration reform would re-emerge in the health care debate. 

Initially waved off, Hispanic advocates jump into health debate
By Krissah Thompson
Thursday, November 12, 2009

After trying to carefully balance their interests in health-care reform and immigration, the nation's Hispanic lawmakers and largest advocacy groups are scrambling to develop a strategy to counter what they see as efforts to shortchange immigrants in health bills on Capitol Hill.

They had tried to keep the two issues apart, concerned, they said, that immigration would distract from health care. [...]

Under the health bill passed in the House on Saturday, illegal immigrants would be allowed to buy insurance on a newly created exchange with their own money and without government subsidies. The bill expected in the Senate would bar illegal immigrants from the exchange altogether. In both the Senate and House, all legal immigrants are eligible for government subsidies to buy insurance on the exchange, but immigrants who have been in the country for less than five years would remain barred by existing law from enrolling in Medicaid and Medicare. [...]

At a meeting in May with Hispanic groups and members of the Congressional Hispanic Caucus, activists pushed for dealing with immigration reform within the health-care debate, [...]

They told us, 'Don't you dare,' " she said of lawmakers. " 'Don't distract. This is about health-care reform and eliminating health-care disparities.' [...]

Similarly, a September meeting with White House policy advisers included a "warning" against confronting the health-care barriers immigrants face because of "fears that conservatives in the Senate could use the issue to kill the bill," Rios wrote on her Web site. [...]

Some Hispanic activists believe their early cautious stand may have backfired, and they are turning up their advocacy, said Lillian Rodriguez Lopez, president of the Hispanic Federation. [...] 

I wonder what type of bribe is going to be offered to get the advocacy groups on board.

First of all thank you for creating this new thread. It was extremely hard separating new and old comments.

Secondly what do you and others think the chances of Obamacare or a slightly watered down version of Obama care will pass and become law before the 2010 elections?

Congress to Healthcare Market: Drop Dead
By Mark J. Perry
Friday, November 13, 2009

Government healthcare reform sure gets a lot of media attention. In just the last month alone there have been about 13,000 new stories containing the word “government” and the phrase “healthcare reform.” In contrast, there have been fewer than 300 news reports during the last month with both of the terms “market based” and “healthcare reform.” That’s a ratio of 43 stories on government healthcare for every one story about market-based healthcare—government-based “reform” has completely monopolized the debate.

Given the momentum in Congress for some kind of government healthcare overhaul, the media attention is understandable. But at the same time that Congress debates different versions of Obamacare and considers various public options, some market-based healthcare solutions have gone largely unnoticed, despite the fact that they have successfully lowered medical costs and improved both access and quality of service.

[...]

Seven examples follow, but when I saw No 6, I had to post this article to see if Strat has any thoughts about Concierge medicine:

6. Concierge medicine. This provides primary medical care from family practice physicians for annual membership fees of $1,000 to $1,800, and the doctor reports directly to the patient, and not an insurance company or Medicare, as his main customer. Concierge practices generally include 24/7 access to a personal physician’s cell phone, same-day appointments with no waiting, personal coordination of care with specialists, personal follow up when admitted to a hospital, and even house calls. While a typical physician has more than 2,000 patients, a concierge physician generally limits his or her practice to between 300 and 600 patients. Examples of concierge medicine providers include MDVIP and Concierge Medicine Today.

The CCH briefing (pdf) is a decent summary on the employer and Medicare and Medicaid related provisions of House Bill HR 3962.

Employer, Medicare Provisions of House Health Care Reform Detailed in New CCH Briefing

RIVERWOODS, Ill., Nov. 13 /PRNewswire/ -- CCH has issued a special Briefing on the employer and Medicare- and Medicaid-related provisions in the House version of health care reform, detailing provisions of the legislation approved on November 7. To access the new Briefing, visit http://hr.cch.com/pdf/SpecialReport_HealthcareReform_11-09.pdf.

The Affordable Health Care for America Act made its way through the House of Representatives with significant changes to the way employers provide health benefits to their employees and major changes for Medicare and Medicaid intact, according to CCH, a part of Wolters Kluwer Law & Business and a leading provider of information and solutions for health care, legal and human resources professionals (hr.cch.com).

The House passed the bill by a vote of 220 to 215. The Senate has yet to vote on health care reform, but if a bill does pass in the Senate, a Conference Committee will be necessary to reconcile differences between House and Senate versions.

Under the House bill, employers with annual payrolls over $750,000 would be required to offer minimum coverage, and contribute at least 72.5 percent of premium costs for individuals and 65 percent of premium costs for families, or else have to pay an additional payroll tax of up to 6 percent of employees' average salary. Employers with annual payrolls under $500,000 would be exempt from the additional tax; those with payrolls between $500,000 and $750,000 would pay a graduated amount. Very small employers would be eligible for a tax credit for offering coverage.

Although a final Senate bill has yet to be merged from versions passed by different committees, it too will have some sort of employer requirement, some sort of financial penalty for employers not offering coverage and some sort of relief and tax credits for small employers.

"If health care reform passes, it seems certain that all but the smallest employers will be assessed some sort of tax or penalty if they do not offer coverage to their employees," said Stephen Huth, managing editor of Spencer's Benefits Reports by Wolters Kluwer Law & Business. Huth is a regular contributor to the blog Health Reform Talk. He tracks the employer-provided health coverage business on a daily basis and regularly answers questions on health benefits issues.

Employers currently offering coverage to their employees would see little change, at least for the first five years of the new rules under health care reform. After that, though, their plans would have to meet the same basic standards as the minimum plans offered in the new Health Insurance Exchange that would be established.

Employers might also see measures aimed at increased taxes for their highest paid employees and limitations on health savings accounts, reimbursement of health expenses under flexible spending arrangements and health reimbursement accounts.

The House bill would prohibit taxpayers from using health flexible spending arrangement (FSA) dollars to pay for over-the-counter medications (unless prescribed by a health professional) and also cap annual contributions to a health FSA offered under an employer-sponsored cafeteria plan at $2,500, indexed for inflation.

Health Insurance Exchange, Public Option

The House bill requires that, like businesses, individuals either provide insurance for themselves or face a financial penalty. Those covered by an employer would meet this requirement.

For individuals who are not currently covered by their employer, and some small businesses, the House bill establishes a new Health Insurance Exchange in which consumers can comparison shop from among health care options that will include private plans, health co-ops, and a new public health insurance option. It also provides "affordability credits" for low-income individuals to help pay for the cost of coverage purchased through the Exchange, available on a sliding scale linked to the federal poverty limit.

The public option would be administered by the Secretary of Health and Human Services, who would negotiate rates for participating providers. The public health insurance option would have startup administrative funding, but would be required to amortize these costs into future premiums to ensure operation on a level playing field with private insurers.

"The public option is one of the more controversial parts of the House version of health care reform, and likely will be modified as the measure moves through the Senate and then the Conference Committee," Huth said.

Medicare, Medicaid Affected

A significant part of the House bill is devoted to changes in Medicare and Medicaid, according to Paul Clark, senior Medicare analyst with Wolters Kluwer Law & Business.

"Medicare and Medicaid involve huge amounts of money, and savings in these programs can help finance other parts of the reform program," Clark said. "In addition, by setting standards of what it will and will not pay for, Medicare/Medicaid can affect the entire health care system, encouraging efficient and cost-savings practices in the treatment of all patients."

Changes include reducing payments to Medicare Advantage providers, eliminating the "donut hole" in Part D drug coverage, incentives and procedures to reduce readmissions to hospitals and changes in reimbursement formulas to encourage greater use of primary care physicians and less use of specialists. Unfilled residency positions would be redistributed to encourage training of primary care physicians, also.

"Over the past 10 years, nearly all of the graduate medical expansion in teaching hospitals has been in subspecialty medicine, while family practice residency programs and three-year training programs that emphasize a generalist training have decreased or have closed," Clark noted. "The premise is that primary care physicians can deliver more care, at a lower cost."

One wasteful program targeted in the legislation is an optional lump-sum payment for power wheelchairs at the time one is first supplied, rather than rental over a 13-month period.

"Many wheelchairs purchased by Medicare during the first month of use are not used beyond the 13-month rental period," Clark said. "Under the House bill, Medicare will continue to pay for wheelchairs for 13 months; then beneficiaries can return the equipment or purchase it."

The House bill also mandates studies of possible savings and improved quality, allocates more money to combating fraud and abuse and expands eligibility for Medicaid.

"Dozens of changes have been proposed," Clark said. "Many of them may eventually be enacted even if health care reform as a whole is unsuccessful."

For More Information

To access the CCH Briefing, visit http://hr.cch.com/pdf/SpecialReport_HealthcareReform_11-09.pdf.

For additional timely and expert discussion of health reform, visit Health Reform Talk, a blog to help professionals decipher the many codes and puzzles of health care reform. The blog, at http://healthcare-legislation.blogspot.com/, covers a wide range of health reform issues and draws on the expertise of Wolters Kluwer Law & Business analysts. Wolters Kluwer Law & Business also publishes Health Care Reform Update NetNews, a free weekly newsletter delivered via e-mail. Click here to view an issue of the Health Care Reform Update NetNews.

SOURCE Wolters Kluwer Law & Business

I tend to disagree with Paul Clark when he says:

"In addition, by setting standards of what it will and will not pay for, Medicare/Medicaid can affect the entire health care system, encouraging efficient and cost-savings practices in the treatment of all patients."

I haven't seen the Federal Government demonstrate its ability to encourage efficient and cost-savings practices in the past, so I'm skeptical of its ability to do so in the future.

I wonder if anybody really believed her. 

Pelosi says she read all of the health bill
By Michael O'Brien
11/14/09 01:08 PM ET

House Speaker Nancy Pelosi (D-Calif.) said Friday that she had read the entirety of the healthcare legislation passed last weekend.

Pelosi told an audience Friday evening at Harvard University that she read the roughly 1,900-page bill, as well as the additional reports and language on the legislation.

"I've read 3,200 pages," Pelosi told the audience at the Kennedy School of Government. "We gave 1,000 pages to each of the three committees and then they reported their findings to us."

[...] 

Want to participate in the discussion of how to mount a coordinated bulwark against the latest tidal wave of socialism in the form of the Barama-nation health care bill. However, I may not be able to strictly adhere to all of Blonde's suggested points for our agenda. One difficulty I have with the health-care "debate" - not only in this forum - but in every venue wherein the topic has been raised is this: the presumption that "we all agree that health care reform is need".

To admit that the US health care system needs reform as a premise: 1) is neither unequivocally supported by facts nor does our system categorically unfavorably compare to that of other countries which have gone the route of adopting a nationalized health care system; and 2) violates everything we know about economics - whatever the school of thought in which you were indoctrinated. If you think you are not getting good value for the dollars you spend on health care then find alternative - oops, the government will not let us try certain things, e.g., holistic medicines or witch doctors for that matter. Rather, they have the AMA tell us what is good for us and everyone blames the insurance companies. By the way, another violation of Blonde's rule, the whole medical insurance thing was a scam which the medical profession including hospitals worked out as a way to "insure" they got paid. And, yet another violation of Blonde's rule: how can this bill be given any credence when the likes of Howard "The Scream" Dean, a medical doctor, who vociferously supports it while he shamelessly campaigns for the position of Health Care Czar.

The point is it doesn't matter what is in the bill - we do not need it; we do no want it; and, we have rejected Ted Kennedy's entreaties in that vein for 40 years.

The premise that the US health care system needs reform is false and we did not send representatives to D.C. for the purpose of creating innovative ways to take our money. Rather, we sent them to Congress to protect us from BIG government. We reject the notion that health care reform is a matter of NATIONAL - as opposed to individual - policy. This is a matter of principle akin to the notion that the King of England had no right to tax us no matter how trivially.

Arguing over the bits that should stay in the bill versus those that should go tacitly accepts health care as a national policy.

We should take some of our scribbling and get it out to as many local publications as possible before Barama does away with freedom of the press. We should campaign against every single representative who voted for the House bill and try to have them removed. We should petition our states to fight on our behalf to exempt us and, if they refuse, we should campaign to have our governors removed.

If all else fails we should exercise our rights to bear arms against the tyranny which this bill represents.